Endoscopic surgical management of congenital Choanal Atresia – Experience in a tertiary-level children's hospital

Open Access

Abstract

Background: Congenital choanal atresia (CCA) is a rare congenital anomaly causing nasal obstruction, respiratory distress, and feeding difficulties in neonates and infants. Endoscopic transnasal repair has emerged as the preferred surgical approach due to its minimally invasive nature and favorable outcomes. Aim of the study: To evaluate the demographic profile, clinical presentation, surgical outcomes, and postoperative complications of infants undergoing endoscopic repair of congenital choanal atresia at a tertiary-level pediatric hospital in Bangladesh. Methods & Materials: This prospective observational study was conducted at Bangladesh Shishu Hospital & Institute from January 2024 to January 2025. Thirty infants aged ≤12 months with unilateral or bilateral CCA confirmed by nasal endoscopy and CT imaging were enrolled. Patients with prior nasal surgery or significant comorbidities were excluded. All patients underwent endoscopic transnasal repair under general anesthesia, with selective stenting based on intraoperative assessment. Intraoperative details, postoperative complications, hospital stay, follow-up outcomes, and surgical success were documented. Comparative analysis between unilateral and bilateral cases was performed. Result: The study included 18 males (60%) and 12 females (40%), with a mean age of 3.6 ± 2.1 months. Bilateral atresia predominated (70%), and mixed-type atresia was most frequent (66.7%). Preoperatively, 80% had feeding difficulty, 66.7% presented with neonatal respiratory distress, and 50% experienced apneic/cyanotic spells? Endoscopic repair had a mean operative time of 42.5 ± 12.4 minutes. Stents were used in 66.7% of cases, and powered instruments in 93.3%. Intraoperative complications were minor, including mild bleeding (20%) and septal injury (3.3%). Postoperative complications included granulation tissue (16.7%), synechiae (10%), and minor bleeding (13.3%), with no cases requiring revision for stenosis. Mean hospital stay was 3.2 ± 1.1 days, and mean follow-up was 9.4 ± 2.7 months. Surgical success, defined as complete nasal patency without recurrence, was achieved in 100% of cases. Comparative analysis showed no statistically significant differences in operative outcomes between unilateral and bilateral cases, except for age at surgery (p = 0.01). Conclusion: Endoscopic transnasal repair of congenital choanal atresia in infants is a safe and effective procedure, associated with minimal complications and excellent short-term outcomes. Bilateral and unilateral cases demonstrate comparable surgical success, highlighting the reliability of the endoscopic approach in a tertiary pediatric setting.